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<div id="logo"><a href="#">ftdbluemood</a>
		<h2><a href="#">Small Company Slogan Goes Here</a></h2></div>
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		<ul>
			<li class="first"><a href="#"  title="">Home</a></li>
			<li><a href="#" title="">Business Application</a></li>
			<li><a href="#" title="">Real Property</a></li>
			<li><a href="#" title="">About</a></li>
			<li><a href="#" title="">Contact</a></li>
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        <h2>Your Options</h2>
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        <h2>Company News</h2>
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       <h2>Have a Question?</h2>
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                <form name="ApplicationForm" method="post" action="">
           <h1>Business Permit Application</h1>
            <table width="947" height="115" border="1">
            
  <tr>
     <td width="335" bgcolor="#D6D6D6" class="table0" ><strong>Date of Application:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</strong><select name="AppDate">
     <?php
			$m= array('January', 'February','March', 'April','May', 'June','July','August','September','October','November','December');
			$mon =date('m')-1;
			for($i=0;$i<12; $i++){
				if ($i==$mon)
				{
					$s="selected='selected'";
				}
				else
				{
					$s="";
					}
			$mo =100+$i+1;
			echo '<option value="'.substr($mo,1,2).'" '.$s.'>'.$m[$i].'</option>';
			}
			
			?>
            </select>
              	<select name="AppDay">
              <?php
			  $d =date('d');
			  for($i=1; $i<date('t')+1; $i++){
				  if($i==$d)
				  {
					  $s="selected='selected'";
				  }
				  else
				  {
					  $s="";}
					  echo'<option value"'.sprintf("%02",$i).'" '.$s.'>'.$i.'</option>';
			  }
			  ?>
             	 </select>
               	<select name="AppYear">
                   <?php
   $y = date('Y');
   for($i=$y; $i>$y-100; $i-- ){
	   if($i==$y)
					{
						$s="selected='selected'";
					}
					else
					{
						$s="";
					}
   echo  '<option value="'.$i.'" '.$s.'>'.$i.'</option>';
   }
    ?>
   
              	</select>
        
			</td>
        
        <td width="273" bgcolor="#D6D6D6"><strong>DTI/SEC/CDA Registration No. :</strong> &nbsp;   &nbsp;<span id="sprytextfield2">
          <input type="text" name="RegNo" id="textfield1" value="" size="33" />
          <span class="textfieldRequiredMsg">A value is required.</span></span></td>
        
        <tr>
         <td bgcolor="#D6D6D6"><strong>Reference No. :</strong> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield3">
           <input name="RefNo" type="text" id="textfield2" value="" size="33" />
           <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    
    	<td bgcolor="#D6D6D6" class="table0" ><strong>DTI/SEC/CDA Date of Registration:</strong>&nbsp; <select name="RegDate">
            <?php
			$m= array('January', 'February','March', 'April','May', 'June','July','August','September','October','November','December');
			$mon =date('m')-1;
			for($i=0;$i<12; $i++){
				if ($i==$mon)
				{
					$s="selected='selected'";
				}
				else
				{
					$s="";
					}
			$mo =100+$i+1;
			echo '<option value="'.substr($mo,1,2).'" '.$s.'>'.$m[$i].'</option>';
			}
			
			?>

            </select>
              <select name="RegDate">
                <?php
			  $d =date('d');
			  for($i=1; $i<date('t')+1; $i++){
				  if($i==$d)
				  {
					  $s="selected='selected'";
				  }
				  else
				  {
					  $s="";}
					  echo'<option value"'.sprintf("%02",$i).'" '.$s.'>'.$i.'</option>';
			  }
			  ?>
              </select>
              <select name="RegDate">
                <?php
   $y = date('Y');
   for($i=$y; $i>$y-100; $i-- ){
	   if($i==$y)
					{
						$s="selected='selected'";
					}
					else
					{
						$s="";
					}
   echo  '<option value="'.$i.'" '.$s.'>'.$i.'</option>';
   }
    ?>
              </select>
              </td>
         </tr>
         
         	<tr>
    			<td bgcolor="#D6D6D6"><strong>Type of Organization:</strong> 
    			     			 
       				<input type="radio" name="TypeOrg" value="" id="RadioGroup1_2" />
      <strong>Single</strong>
     <input type="radio" name="TypeOrg" value="" id="RadioGroup1_2" />
      <strong>Partnership</strong>
      <input type="radio" name="TypeOrg" value="" id="RadioGroup1_" /> 
      
      <strong>Corporation</strong>
      <input type="radio" name="TypeOrg" value="" id="RadioGroup1_2" />
      <strong>Cooperative</strong>
 
      </td>
    <td bgcolor="#D6D6D6"><strong>CTC No. :</strong><span id="sprytextfield7">
      <input name="CTCNo" type="text" id="textfield3" value="" size="20" />
      <span class="textfieldRequiredMsg">A value is required.</span></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>TIN:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield8">
      <input name="TIN" type="text" value="" size="20" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
   </tr>
</table>

		
        
        <table width="947" border="1">
  <tr>
    <td width="600" bgcolor="#D6D6D6"><strong>Are you enjoying tax inactive from Government Entity?</strong>
     <input type="radio" name="RadioGroup1" value="" id="RadioGroup1_2" />Yes
     <input type="radio" name="RadioGroup1" value="" id="RadioGroup1_2" />
     <strong>No</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
     <strong>Please specify the entity:</strong> </td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Name of Tax payer:</strong> </td>
  </tr>
  </table>
    	<table width="946" border="1">
  		<tr>
    		<td width="193" bgcolor="#D6D6D6"><strong>Last Name:</strong><span id="sprytextfield1">
    		  <input name="TPLName" type="text" id="textfield4" value="" size="25" />
    		  <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    		<td width="192" bgcolor="#D6D6D6"><strong>First Name:</strong><span id="sprytextfield4">
    		  <input name="TPFName" type="text" id="textfield5" value="" size="25" />
    		  <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    		<td width="229" bgcolor="#D6D6D6"><strong>Middle Name:</strong><span id="sprytextfield5">
    		  <input name="TPMName" type="text" value="" size="25" />
    		  <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  			</tr>
		</table>

		<table width="945" border="1">
  		<tr>
    	<td width="723" bgcolor="#D6D6D6"><strong>Business Name:</strong> &nbsp;&nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<span id="sprytextfield6">
    	  <input name="BName" type="text" id="textfield6" value="" size="60" />
    	  <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  	   </tr>
 	 	<tr>
    
    	<td bgcolor="#D6D6D6"><strong>Trade Name/Franchise:</strong><span id="sprytextfield9">
    	  <input name="TrdeNme_Francise" type="text" id="textfield7" value="" size="60" />
    	  <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  		</tr>
 		 <tr>
    	<td bgcolor="#D6D6D6"><strong>Name of President/Treasurer of Corporation:</strong> </td>
  		</tr>
		</table>

	<table width="944" border="1">
  		<tr>
    	<td width="196" bgcolor="#D6D6D6"><strong>Last Name:</strong><span id="sprytextfield10">
    	  <input name="PLName" type="text" id="textfield8" value="" size="25" />
    	  <span class="textfieldRequiredMsg">A value is required.</span></span>&nbsp;</td>
    	<td width="199" bgcolor="#D6D6D6"><strong>First Name:</strong><span id="sprytextfield11">
    	  <input name="PFName" type="text" value="" id="textfield9" size="25" />
    	  <span class="textfieldRequiredMsg">A value is required.</span></span>&nbsp;</td>
    	<td width="219" bgcolor="#D6D6D6"><strong>Middle Name:</strong><span id="sprytextfield12">
    	  <input name="PMName" type="text" id="textfield10" value="" size="25" />
    	  <span class="textfieldRequiredMsg">A value is required.</span></span>&nbsp;</td>
  		</tr>
		</table>

        
        <table width="944" border="1">
  <tr>
    <td width="559" bgcolor="#D6D6D6"><div align="center"><strong>Business Address</strong></div></td>
    <td width="559" bgcolor="#D6D6D6"><div align="center"><strong>Owner's Address</strong></div></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>House No./Bldg.No. Building Name: </strong><span id="sprytextfield13">
      <input name="BHNo_BdlgNoBldgN" type="text" id="textfield11" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    <td bgcolor="#D6D6D6"><strong>House No./Bldg. No. Building Name:</strong><span id="sprytextfield14">
      <input name="OHNo_BdlgNoBldgN" type="text" id="textfield12" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Unit No. :</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield15">
      <input name="BUnitNo" type="text" id="textfield13" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    <td bgcolor="#D6D6D6"><strong>Unit No.: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield16">
      <input name="OUnitNo" type="text" id="textfield14" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Street : </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield17">
      <input name="BStreet" type="text" id="textfield15" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    <td bgcolor="#D6D6D6"><strong>Street: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield18">
      <input name="OStreet" type="text" id="textfield16" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Barangay: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield19">
      <input name="BBrgy" type="text" id="textfield17" value="" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
    <td bgcolor="#D6D6D6"><strong>Barangay:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span id="sprytextfield20">
      <input name="OBrgy" type="text" value="" id="textfield18" size="40" />
      <span class="textfieldRequiredMsg">A value is required.</span></span></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Subdivision: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="BSubd" type="text" id="textfield19" value="" size="40" /></td>
    <td bgcolor="#D6D6D6"><strong>Subdivision: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="OSubd" type="text" id="textfield20" value="" size="40" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Municipality: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="BMun" type="text" id="textfield21" value="" size="40" /></td>
    <td bgcolor="#D6D6D6"><strong>Municipality: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="OMun" type="text" id="textfield22" value="" size="40" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Province: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="BPro" type="text" id="textfield23" value="" size="40" /></td>
    <td bgcolor="#D6D6D6"><strong>Province:</strong> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="OPro" id="textfield24" type="text" value="" size="40" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Tel No.: </strong><input name="BTelNo" type="text" id="textfield25" value="" size="40" /></td>
    <td bgcolor="#D6D6D6"><strong>Tel No.: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="OTelNo" type="text" id="textfield26" value="" size="40" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Email Address: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="BEAdd" type="text" id="textfield27" value="" size="40" />
      </td>
    <td bgcolor="#D6D6D6"><strong>Email Address: </strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="OEAdd" type="text" id="textfield28" value="" size="40" /></td>
  	</tr>
	</table>
			<table width="944" border="1">
  			<tr>
   			 <td width="800" bgcolor="#D6D6D6"><strong>Property Index Number (PIN):</strong> <input name="PIN" type="text" id="textfield29" value="" size="15" /></td>
    		</tr>
		</table>

		<table width="944" border="1">
 		 <tr>
   		 <td width="149" bgcolor="#D6D6D6"><strong>Business Area(in sq. m):</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
      		<input name="BArea" type="text" id="textfield30" value="" size="15" /></td>
   <td width="213" bgcolor="#D6D6D6"><strong>Total No. of Employees In Establishment:</strong>
      		<input name="TNoOfEmp" type="text" id="textfield31" value="" size="27" /> </td>
    <td width="252" bgcolor="#D6D6D6"><strong>No. of Employees Residing in LGU:</strong> <input name="NoOfEmpResidingLGU" type="text" id="textfield32" value="" size="25" /></td>
  		</tr>
		</table>

<table width="944" border="1">
  <tr>
    <td width="620" bgcolor="#D6D6D6"><strong>If place of Business is Rented, please identify the following: Lessor's Name</strong></td>
  </tr>
</table>
<table width="943" border="1">
  <tr>
    <td width="372" bgcolor="#D6D6D6"><strong>Last Name:</strong> <input name="LLName" type="text" value="" id="textfield33" size="25" /></td>
    <td width="395" bgcolor="#D6D6D6"><strong>First Name:</strong> 
      <input name="LFName" type="text" id="textfield34" value="" size="25" /></td>
    <td width="345" bgcolor="#D6D6D6"><strong>Middle Name: </strong>
      <input name="LMName" type="text" id="textfield35" value="" size="25" /></td>
  </tr>
</table>

<table width="944" border="1">
  <tr>
    <td bgcolor="#D6D6D6"><strong>Lessor's Address:</strong> </td>
  </tr>
</table>
<table width="943" border="1">
  <tr>
    <td width="308" bgcolor="#D6D6D6"><strong>House No./Bldg. No.Building Name:</strong><input name="LHNo_BdlgNoBldgN" type="text" id="textfield36" value="" size="45" /></td>
    <td width="310" bgcolor="#D6D6D6"><strong>Municipality:</strong><input name="LMun" type="text" id="textfield37" value="" size="45" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Street:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="LStreet" type="text" id="textfield38" value="" size="45" /></td>
    <td bgcolor="#D6D6D6"><strong>Province:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="LPro" type="text" id="textfield39" value="" size="45" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Barangay:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="LBrgy" type="text" value="" id="textfield40" size="45" /></td>
    <td bgcolor="#D6D6D6"><strong>Tel. No.</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="LTel" type="text" value="" id="textfield41" size="45" /></td>
  </tr>
  <tr>
    <td bgcolor="#D6D6D6"><strong>Subdivision:</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="LSubd" type="text" id="textfield42" value="" size="45" /></td>
    <td bgcolor="#D6D6D6">&nbsp;</td>
  </tr>
</table>
<table width="943" border="1">
  <tr>
    <td width="285" height="26" bgcolor="#D6D6D6"><strong>Incase of Emergency</strong></td>
    <td width="620" bgcolor="#D6D6D6"><strong>Contact Person/Tel No./Mobile Phone/Email Address:</strong> <input name="LContactNo" type="text" id="textfield43" value="" size="81" /></td>
  </tr>
</table>
<table width="943" border="1">
  <tr>
    <td colspan="2" bgcolor="#D6D6D6"><strong>Business Activity</strong></td>
    <td width="56" rowspan="2" bgcolor="#D6D6D6"><div align="center"><strong>No. of Units</strong></div></td>
    <td width="119" rowspan="2" bgcolor="#D6D6D6"><div align="center"><strong>Capitalization(for New Business)/<strong></div></td>
    <td colspan="2" bgcolor="#D6D6D6"><div align="center"><strong>Gross Sales/Receipts (for renewal</strong>)</div></td>
  </tr>
  <tr>
    <td width="89" rowspan="3" valign="top" bgcolor="#D6D6D6"><strong>Code:</strong> <br /><input name="DOA" type="text" value="" size="15" /></td>
    <td width="66" bgcolor="#D6D6D6"><div align="center"><strong>Line of Business</strong></div></td>
    <td width="109" bgcolor="#D6D6D6"><div align="center"><strong>Essential</strong></div></td>
    <td width="163" bgcolor="#D6D6D6"><div align="center"><strong>Non-Essential</strong></div></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td colspan="2" bgcolor="#D6D6D6">&nbsp;</td>
    <td bgcolor="#D6D6D6">&nbsp;</td>
    <td bgcolor="#D6D6D6">&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td colspan="2" bgcolor="#D6D6D6">&nbsp;</td>
    <td bgcolor="#D6D6D6">&nbsp;</td>
    <td bgcolor="#D6D6D6">&nbsp;</td>
  </tr>
</table>
<table width="942" height="70" border="1">
  <tr>
    <td valign="top" bgcolor="#D6D6D6"><div align="center"><h3>Oath of Undertaking :</h3><br />
  
    </div><div><strong>I undertake to comply with the regulatory requirement and other deficiencies within 30 days
           from release of the Business Permit.</strong></div></td>
  </tr>
    </table>
    
    <input type="submit" name="btn_submit" value="Submit" >
    <input type="reset" name="reset" value="Reset" />
    </form>
    
    
    <?php
		
		if(isset($_POST['btn_submit']))
		   {
	include "db_config.php"; 
	$table_name = "taxpayer";
	$table_name2 = "business";
	$table_name3 = "application";
	$table_name4 = "lessor";
	
	$sql = "INSERT INTO $table_name(TPID, TPLName, TPFName, TPMName, OHNo_BdlgNoBldgN, OUnitNo, OStreet, OBrgy, OSubd, OMun, OPro, OTelNo) 
VALUES('','$_POST[TPLName]','$_POST[TPFName]','$_POST[TPMName]','$_POST[OHNo_BdlgNoBldgN]','$_POST[OUnitNo]','$_POST[OStreet]','$_POST[OBrgy]','$_POST[OSubd]','$_POST[OMun]','$_POST[OPro]','$_POST[OTelNo]' )";

	$sql2 = "INSERT INTO $table_name2(BNo, BName, TrdeNme_Fran, PLName,PFName,PMName, BHNo_BdlgNoBldgN, BUnitNo, BStreet, BBrgy, BSubd, BMun, BPro, BTelNo, BEAdd, BArea, TNoOfEmp, NoOfEmpResidingLGU, TypeOrg) 
VALUES('','$_POST[BName]','$_POST[TrdeNme_Fran]','$_POST[PLName]','$_POST[PFName]','$_POST[PMName]','$_POST[BHNo_BdlgNoBldgN]','$_POST[BUnitNo]','$_POST[BStreet]','$_POST[BBrgy]','$_POST[BSubd]','$_POST[BMun]','$_POST[BPro]','$_POST[BTelNo]','$_POST[BEAdd]','$_POST[BArea]','$_POST[TNoOfEmp]','$_POST[NoOfEmpResidingLGU]','$_POST[TypeOrg]' )";  
	
	$sql3 = "INSERT INTO $table_name3(AppNo, AppDate, AppDay, AppYear, Taxyear) 
VALUES('','$_POST[AppDate]','$_POST[AppDay]','$_POST[AppYear]','$_POST[Taxyear]')";
	
	$sql4 = "INSERT INTO $table_name4(LLName, LFName, LMName, LHNo_BdlgNoBldgN, LStreet, LBrgy, LSubd, LMun, LPro, LTel, LContactNo) 
	VALUES
('$_POST[LLName]','$_POST[LFName]','$_POST[LMName]','$_POST[BHNo_BdlgNoBldgN]','$_POST[LStreet]','$_POST[LBrgy]','$_POST[LSubd]','$_POST[LMun]','$_POST[LPro]','$_POST[LTel]','$_POST[LContactNo]' )";

	
$result = mysql_query($sql,$connection) or die (mysql_error());
$result2 = mysql_query($sql2,$connection) or die (mysql_error());
$result3 = mysql_query($sql3,$connection) or die (mysql_error());$result4 = mysql_query($sql4,$connection) or die (mysql_error());
echo "<font color=\"#000066\"><h3>FILLED OUT COMPLETE</h3></font>";

	}
	
		   ?>
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